Influenza Virus Mashup

Via the Ministry of Agriculture and Forests, a report by Tenzin Dhendup, Director General of the Department of Livestock: Bird flu containment update.

The team has been able to cover and carry out activities over a huge region which includes nine large areas (villages). We have been able to Depopulate, Decontaminate and Dispose of 173 numbers of birds. We worked in two shifts, one in the morning and the other in the afternoon. 

It has been inconvenient but the team, even whilst wearing PPE (personal protection equipment), has been successful in working and running after the birds, especially with the extreme heat of the area.
  

We have also put in place the disinfection for the vehicles plying from Phuentsholing to Thimphu at Singhi bridge which falls at the end of Pasakha. As there is not a single appropriate place from Rinchending to Sorchen, the decision for the placement of the second disinfection spot may be placed more towards Kamji at a spot that has both a water source and an electricity supply. Therefore, a generator may be used. 
  

We will be working with two groups matching our group with the availability of power spray machines. We will be covering at least 6 big villages.
  

We will be doing the 24 hrs decontamination along with decontamination after 7 days. It is a lot of work but nevertheless, I am very happy to report that after working for long hours, I can still see a lot of energy amongst our colleagues with a lot of positive energy. We estimate that we have another two days of hard work which our team is determined to take till the end.

Via The Jakarta Globe, an interesting piece, though it certainly reads like government spin: New Avian Flu Committee Shows Indonesia’s Maturing Approach to Epidemics. Excerpt:

For many national and international health experts the news that the Indonesian National Committee for Avian Influenza and Pandemic Influenza Control will be dissolved in the next few weeks was disturbing. 

Fresh outbreaks of bird flu have recently been recorded in a number of provinces and several patients have tested positive for the disease. It just doesn’t make sense why the bird flu battle has to end now. 

But then a senior Agriculture Ministry official announced a new group would be formed to replace the aforementioned committee, known as Komnas FBPI. 

The announcement of the future committee, to be called the National Committee on Zoonosis, or Komnas Zoonosis, is a welcome sign of commitment from the central government. It also shows a shift in the government’s paradigm and a decision to treat bird flu as one of the many animal-sourced diseases that needs to be tackled. 

The year 2006 was the worst year in Indonesia’s bird flu history. More than 50 people contracted the disease and 80 percent of them died. It was the year that the country surpassed Vietnam as the world’s leader in numbers of confirmed bird flu cases as well as fatalities. 

And it was the year the world was shocked by the discovery of two bird flu clusters in Indonesia: the Karo and the Garut clusters. The earlier cluster appeared in a family, while the latter broke out in a community. 

The cause and mode of infection remains unknown. Scores of scientific papers published in world renowned scientific journals have not conclusively solved the mystery. The one thing that is certain is that the H5N1 virus, rampant in backyard poultry, was the cause of the infection and deaths in both clusters. 

The birth of Komnas FBPI intensified the war against bird flu. The committee launched the first massive nationwide health program since the 1998 reformation: the Tanggap Flu Burung (Take Action Against Bird Flu) campaign. Although disliked by some ministry officials, who argued that Komnas usurped their authority, the committee helped increase communication and coordination between government institutions and international donor agencies. 

But the question remains, after tens of millions of dollars spent, thousands of civil servants mobilized and millions of people taking preventive measures, why is H5N1 still around? 

There is no easy answer. One of Komnas FBPI’s executives says, “We probably have to face the fact that we have to live side by side with this virus.” 

In short, bird flu will remain a public health threat, but Komnas and its campaigns have made people aware of how to protect themselves. 

So, why Komnas Zoonosis? The antibird flu campaign has taught the government a very important lesson: a public health threat requires multi-sector cooperation. 

Although bird flu is still with us, the number of cases has been diminishing annually since the campaign was launched. This decline has been influenced by many factors. 

First, the success of the campaign in teaching people to wash their hands, cook their meat until well done, cage their chickens and go to a doctor when symptoms of influenza appear. This campaign has reached over 90 percent of Indonesians, according to a UNICEF survey. 

Second, community training carried out by numerous organizations. This training has facilitated community members discussing and resolving their own problems. It has resurrected the old practice of neighborhood meetings. 

Third, the press has played a vital role. Media loves bird flu news. It involves a pandemic: deaths, outbreaks and economic impacts. Noted risk communication expert Peter Sandman says “public attention correlates with media attention.” 

The more bird flu makes headlines, the more people care about the risk it carries. Bird flu headlines have kept the public informed about the deadly virus. Some media have almost gone overboard in making bird flu news a priority and continuously promoting prevention. 

Fourth, the development of a pandemic preparedness plan. The war against bird flu has forced the government and many businesses to organize and draft pandemic preparedness and response plans, as well as business contingency and continuity plans. 

These plans have been tested on many scales, from table top exercises such as mock up disaster response forums, to full scale simulations that include field exercises with mobilization of equipment and personnel. 

The government cannot afford to lose the momentum and resources it has built in the war against H5N1. It wants to and it must keep this momentum alive.

(Fri, 26 Feb 2010 17:50:00 +0000)

# 4387

From Ironorehopper via his blog and FluTrackers we get this press release from the Hong Kong government about the discovery of a reassorted swine flu virus discovered last month in a pig from mainland China.

First the press release, then some discussion.

Swine Influenza Virus reassorted with Pandemic H1N1 

February 26, 2010
Issued at HKT 22:37

The University of Hong Kong (HKU) had found in its regular influenza virus surveillance programme that one sample taken from a pig at the Sheung Shui Slaughterhouse on January 7 contained a virus which was essentially a swine influenza virus but had picked up a pandemic H1N1 gene by genetic reassortment. There is no cause for alarm for public health and pork remains safe for consumption. Government is closely monitoring developments and shall continue to keep the public informed.

 

This is the first time that reassortment of swine influenza virus with the pandemic H1N1 virus was found in the surveillance programme.

 

Prof Malik Peiris, the HKU expert in charge of the surveillance programme, considered that the findings of reassortment between the pandemic H1N1 virus and swine influenza virus was not totally unexpected. These events were likely occurring worldwide and its detection in Hong Kong was purely the consequence of intensive surveillance.  Further tests are being conducted by HKU to determine if there are any particular  characteristics of this strain.

 

A spokesman for the Centre for Food Safety (CFS) reaffirmed that the World Health Organization, World Organisation for Animal Health and Food and Agriculture Organization of the United Nations had stated that pork and pork products which were handled properly and thoroughly cooked were safe for human consumption.  It is safe to eat pork and pork products that are cooked to an internal temperature of 70 degrees Celsius or above.

 

A spokesman for the Centre for Health Protection also said: “Laboratory surveillance on human specimens by the Department of Health (DH) has not detected similar viruses in humans.

 

“There is no sign that the virus is present in Hong Kong population at this time.  The DH will maintain intensive surveillance of influenza in humans.

 

“Preliminary findings also show that the virus is sensitive to antiviral drug, oseltamivir. ”

 

The CFS spokesman said:“The sample was taken from a pig imported from the Mainland. We have informed the Mainland authorities so that they can further step up the monitoring and inspection of the registered farms supplying live pigs to Hong Kong.”

(Continue . . . )

 

We talk about the reassortment of flu viruses in these pages with some regularity.  Essentially, it occurs when two different flu viruses infect the same cell in a host at the same time, and swap gene segments.

The host can be a human, a bird, a pig, or any other mammal capable of being infected by multiple influenza viruses.   How often this happens is unknown, but only rarely does it result in a new, viable virus that threatens humans.

Hong Kong is perhaps the most diligent region on earth for monitoring and examining flu viruses.  Located adjacent to what many consider to be the `cradle of influenza’, mainland China, they are often the first to identify new and exotic strains.

We will eagerly await further details on exactly what swine virus, and what H1N1 gene segments, were involved.  And what, if any, changes in pathogenicity or transmissibility may have occurred

For now this discovery of a reassorted virus is more of a scientific curiosity than a public health threat. There are no reports of any further spread of the virus at this time. 

This is, however, an important reminder that the only constant with influenza viruses is that they constantly change.  Whether it be via antigenic drift (small mutations) or antigenic shift (reassortment), virologists are quick to remind us.

Shift happens.

While the recent drop in influenza activity around the globe has been a welcome respite, we shouldn’t allow ourselves to be lulled into complacency.  

There are no guarantees that we’ll have another 40 years before the next pandemic virus emerges.

(Fri, 26 Feb 2010 15:15:00 +0000)

# 4386

While pandemic H1N1 continues to be reported in many areas of the world, the levels being seen today are far lower than what was reported a couple of months ago.  The other seasonal strains (H1N1 and H3N2) are being reported only sporadically around the world.

The question on everyone’s mind is; what (if anything) will rise to fill the void?

Over the past few weeks, reports of influenza B infections have been steadily increasing, particularly out of Hong Kong and China.   The short course on influenza B from the CDC reads:

Influenza Type B

Influenza B viruses are usually found only in humans. Unlike influenza A viruses, these viruses are not classified according to subtype. Influenza B viruses can cause morbidity and mortality among humans, but in general are associated with less severe epidemics than influenza A viruses. Although influenza type B viruses can cause human epidemics, they have not caused pandemics.

The chart(s) below show that of the 2076 samples recently tested by FluNet that proved positive for influenza (week of Feb 6-13), more than 50% were Influenza B.

What this portends for the future is unknown, since the start of the flu season in the southern hemisphere is still several weeks away.  Will H1N1 make a comeback? 

We’ll have to wait and see.

(blow up of last 3 months)

Here then is the latest influenza virological surveillance report from the World Health Organization.   You’ll find additional information in Pandemic (H1N1) 2009 - update 89.

 

Weekly virological surveillance update

26 February 2010 — Pandemic influenza A(H1N1) 2009 infections have continued to decrease in most countries of the Northern Hemisphere in recent weeks. Little activity has been reported in the Southern Hemisphere in 2010 to date. In nearly all countries where human influenza infection is reported, the pandemic influenza A (H1N1) continues to be the predominant subtype among all influenza A viruses subtyped (87.3% in North America region, AMR, 94% in EUR and 90% global). Seasonal A(H1N1) viruses continue to be detected very sporadically. Sporadic influenza A(H3N2) activity has been reported from some countries in recent weeks. Influenza B activity continued to increase in China and Hong Kong SAR China.

 

Based on FluNet reporting for the week from 6-13 February 2010*, the total number of specimens reportedly positive for influenza viruses by NIC laboratories was 2,076. Of these, 1,003/2,076 (48.3%) were typed as influenza A and 1,073 (51.7%) as influenza B. Of all sub-typed influenza A viruses, 90% (781/866) were pandemic A(H1N1) 2009. Hong Kong SAR China has reported increased influenza B activity in recent weeks accounting for 56.1% of all influenza detections in the reporting week, while in China it accounted for 83.5%.

(Continue . . . )

Via The New Straits Times: First Vietnam bird flu death in 2010. Excerpt:

A 38-year-old woman has become the first victim of bird flu in Vietnam in 2010, bringing the country’s toll from avian influenza to 58, the health ministry said Friday. 

The woman died Tuesday in the southern province of Tien Giang after two days of unsuccessful hospital treatment, said the ministry in an online statement. 

The victim had killed and cooked sick waterfowl, the statement added. Vietnam’s last death from the H5N1 virus was in December. 

At present, outbreaks of bird flu among poultry have been reported in five provinces. 

Vietnam ranks second after Indonesia for the highest bird flu death toll, according to the World Health Organization.

Via The Los Angeles Times, an excellent article by plague historian Wendy Orent: What H1N1 taught us. Excerpt (but read the whole thing):

We have learned a lot from the 2009 H1N1 swine flu pandemic. 

We have learned, for example, that one basic assumption about pandemics was wrong: You don’t need a radical mutation in a flu virus to produce a pandemic. All you need is enough change within a surface protein for a new strain to blow past acquired immunity and blaze around the world, as this one did. 

And we’ve seen that not every pandemic strain is especially lethal. The Centers for Disease Control and Prevention in Atlanta estimated that 11,690 Americans had died of swine flu by mid-January. In a “normal” flu season, the CDC estimates that 36,000 Americans die. 

As Peter Palese, an eminent flu virologist from Mount Sinai Hospital in New York, put it, “We were lucky — this was a mellow virus.” It lacks the virulence factors that make highly pathogenic bird flu, or the 1918 pandemic flu virus, so deadly. 

In the beginning, the pandemic seemed to have an ominous affinity for the young. But this turned out to be mostly a matter of resistance. Many people born before 1957 have some cross-immunity to the virus because of their exposure to a previous H1 outbreak. 

So older people — the usual victims of seasonal flu — caught the new virus at much lower rates. And even among young people, though the attack rate was ferocious and many millions were infected, only a tiny percentage of those who got the flu died.

(Fri, 26 Feb 2010 12:03:00 +0000)

# 4386

Commonground posting on her website and on FluTrackers has several reports this morning on the first H5N1 fatality out of Vietnam for the year.   The case involves a 38-year-old woman from Tien Giang Province who died on Feb 23rd.

Map from wikipedia

Confirmed the first case of death due to influenza A (H5N1) in 2010

Director of Department of Preventive Health and Environment

 

(Ministry of Health) Nguyen Huy Nga has confirmed a female patient, 38 years old, residing in An Thai Trung commune, Cai Be district, Tien Giang province died from influenza A ( H5N1). This is the first case of death due to influenza A (H5N1) in 2010.

 

Patients with disease onset date of February 13, had own treatment at home and to commune health treatment but did not help. As of February 21, patients more tired, chest pain, difficulty breathing, was taken to the treatment at the Hospital Sa Dec, Dong Thap province. Here, the patient was diagnosed: Pneumonia due to severe virus - severe shock infection. Although the resuscitation, treatment of positive, but the evolutions severe disease, patients die on February 23 at 09h00.

 

Epidemiological investigation showed that patients with a history of slaughtering and processing aquatic birds sick. On February 23, Pasteur Institute Ho. Ho Chi Minh answered test results positive for influenza A virus (H5N1). So this is the first fatality due to influenza A (H5N1) in 2010.

(Continue . . . )

(Fri, 26 Feb 2010 11:33:00 +0000)

# 4385

Five years ago we had four antiviral drugs that worked pretty well against nearly all of the influenza viruses in circulation.  We had the old standbys of Amantadine and Rimantadine, which had been around nearly 50 years, along with the relatively new drugs Tamiflu and Relenza.

But by late 2005 it became apparent that the H3N2 seasonal flu virus was becoming resistant to the older class of drugs.   The cause was suspected by many to stem from the illegal and indiscriminate use of Amantadine as an additive to chicken feed in China.

While still effective against the H1N1 seasonal virus, in January of 2006 the CDC recommended that drugs of the Amantadine class no longer be used against influenza.    Tamiflu (oseltamivir) was the new `go to’ drug, with Relenza (zanamivir) as a backup.

With the prospects of a pandemic on the horizon, many nations invested heavily in Tamiflu, stockpiling hundreds of millions of capsules.  

Then . . . in 2008, we began to see signs of resistance forming to Tamiflu as well.   This time in seasonal H1N1.   Within a year, nearly all seasonal H1N1 viruses were resistant.

While still effective against the H3N2 viruses, novel H1N1, and most of the avian strains there are concerns that the `life’ of Tamiflu may be limited.  Victories against viruses and bacteria sometimes prove to be short-lived.

Therefore, new antivirals are a hot research field right now.

One of the brighter prospects undergoing testing is CS-8958, or laninamivir, being developed by Daiichi Sankyo Co Ltd. 

PLoS Pathogens has a study revealing promising test results in its latest edition entitled:

Efficacy of the New Neuraminidase Inhibitor CS-8958 against H5N1 Influenza Viruses

Maki Kiso, Shuku Kubo, Makoto Ozawa, Quynh Mai Le, Chairul A. Nidom, Makoto Yamashita, Yoshihiro Kawaoka

At least two of the authors listed above should be familiar names to readers of this blog;  Yoshihiro Kawaoka and C. A. Nidom.

A few choice excerpts from the abstract, followed by Maggie Fox’s story from Reuters.

ABSTRACT

CS-8958 functions as a long-acting NA inhibitor in vivo (mice) and is efficacious against seasonal influenza strains following a single intranasal dose. Here, we tested the efficacy of this compound against H5N1 influenza viruses, which have spread across several continents and caused epidemics with high morbidity and mortality.

 

We demonstrated that R-125489 interferes with the NA activity of H5N1 viruses, including oseltamivir-resistant and different clade strains. A single dose of CS-8958 (1,500 µg/kg) given to mice 2 h post-infection with H5N1 influenza viruses produced a higher survival rate than did continuous five-day administration of oseltamivir (50 mg/kg twice daily).

 

Virus titers in lungs and brain were substantially lower in infected mice treated with a single dose of CS-8958 than in those treated with the five-day course of oseltamivir. CS-8958 was also highly efficacious against highly pathogenic H5N1 influenza virus and oseltamivir-resistant variants. 

These results stem from a mouse model, and one must always be mindful that what works in mice doesn’t always work in humans. 

Still, the big news is that one dose of this inhaled antiviral works as well as a five day regimen of Tamiflu (in mice), and that it is effective against antiviral resistant strains of H5N1.  

The manufacturer hopes to bring this new drug to market next year.

Maggie Fox picks up the story for us.

New inhaled drug protects from flu in single dose

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – A single dose of an experimental influenza drug saves more mice from H5N1 avian influenza than the preferred drug Tamiflu, researchers reported on Thursday, and can also protect against infection.

 

The tests of Daiichi Sankyo Co Ltd’s CS 8958 or laninamivir show one inhaled dose worked better than Tamiflu to keep mice alive when infected with a normally deadly dose.

 

The report in the Public Library of Science Journal PLoS Pathogens covers one of the dozens of ongoing studies of a new batch of influenza drugs being developed by a variety of companies.

 

“Importantly, a single dose of CS-8958 conferred a more potent and long-lasting protective effect to mice against H5N1 influenza viruses than that of oseltamivir phosphate,” Yoshihiro Kawaoka of the University of Wisconsin and colleagues wrote in their report.

(Continue . . . )

(Fri, 26 Feb 2010 06:22:13 -0500)

It is becoming conventional wisdom that the 2009 H1N1 pandemic was not as severe as a bad seasonal flu year. That might be true, although I don’t find it much comfort because a bad seasonal flu year is no less bad for being more familiar. But I am not yet willing to assent to the conventional wisdom yet. I don’t think we have had sufficient time to collate all the information that would enable us to make that kind of judgment, which sometimes takes years to evaluate. However bad it was or wasn’t, the pandemic flu strain could kill you just as dead as any other flu. CDC has just released updated information on the risk factors that seem to make it more likely you will wind up severely ill and hospitalized. It confirms what we knew, that certain pre-existing medical conditions up the risk substantially and some of them are extremely common. The analysis was done for both children and for adults, and there are similarities and differences.

Read the rest of this post… | Read the comments on this post…

Via Viet Nam News, a report datelined Ho Chi Minh City: Illegal poultry trade stokes bird flu fears. Excerpt:

Veterinary officials in HCM City fear the avian flu that has already hit other localities in the country could re-emerge in the city and other southern provinces. 

Their worry stems from the fact that illegal slaughter and sales of poultry was rampant before and after the Tet holidays in the city and surrounding areas. 

The officials say that HCM City faces the threat of bird flu from the widespread smuggling in of water fowls from neighbouring provinces as demand of poultry increased in recent days. 

Illegal poultry trading has been very popular in HCM City’s outlying districts, the officials say. 

They are worried that the epidemic can return strongly as many localities have ignored prevention tasks and the flu has been reported in seven provinces around the country. 

Among the poultry hotspots in the city are the Cau market on Quang Trung Street in Go Vap District, the Tran Chanh Chieu Market in District 5 and Binh Tri Dong Market in Binh Tan District. Other markets in districts 3, 4, 5, 6, 7, 8, 10 and 11 are also major poultry trading sites. 

There are many notorious wet markets where ducks and chicken have been slaughtered illegally for many years, and the practice continues to flourish despite the bird flu scare. 

Pham Xuan Thao, head of the city Veterinary Department, told the Nguoi Lao Dong (Labourer) newspaper that his department would not be able to manage the epidemic without support from other departments and authorities. 

He expressed unhappiness that district authorities have not closed down these illegal markets. Thao said that the city has asked district level administrations to crack down on illegal poultry trading and hand out stiff penalties to violators.